Provider Demographics
NPI:1740380799
Name:OTHON, JAVIER A (PT)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:A
Last Name:OTHON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16371 SW 53RD TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5185
Mailing Address - Country:US
Mailing Address - Phone:305-323-5833
Mailing Address - Fax:305-387-9332
Practice Address - Street 1:13601 SW 78TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3203
Practice Address - Country:US
Practice Address - Phone:305-323-5833
Practice Address - Fax:305-387-9332
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19306225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0767AMedicare ID - Type Unspecified